Tonsillitis natural history, complications and prognosis: Difference between revisions
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== | ==Complications== | ||
An [[abscess]] may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a [[peritonsillar abscess]] (or [[quinsy]]). | |||
Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading [[septicaemia]] infection ([[Lemierre's syndrome]]). | |||
In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years),<ref>{{cite book | title=Management of Sore Throat and Indications for Tonsillectomy | url=http://www.sign.ac.uk/guidelines/fulltext/34/index.html | chapter=6.3 Referral Criteria for Tonsillectomy | chapterurl=http://www.sign.ac.uk/guidelines/fulltext/34/section6.html | publisher=[http://www.sign.ac.uk Scottish Intercollegiate Guidelines Network] | id=ISBN 1-899893-66-0 | year=1999 | month=January}} - notes though that these criteria "have been arrived at arbitrarily" from:<br>{{cite journal |author=Paradise JL, Bluestone CD, Bachman RZ, ''et al'' |title=Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials |journal=N. Engl. J. Med. |volume=310 |issue=11 |pages=674–83 |year=1984 |pmid=6700642 |doi=}}</ref><ref name="pmid12093941">{{cite journal |author=Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M |title=Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children |journal=Pediatrics |volume=110 |issue=1 Pt 1 |pages=7–15 |year=2002 |pmid=12093941 |doi=10.1542/peds.110.1.7}} - this later study by the same team looked at less severely affected children and concluded "modest benefit conferred by tonsillectomy or adenotonsillectomy in children moderately affected with recurrent throat infection seems not to justify the inherent risks, morbidity, and cost of the operations"</ref><ref name="pmid15195718">{{cite journal |author=Wolfensberger M, Mund MT |title=[Evidence based indications for tonsillectomy] |language=German |journal=Ther Umsch |volume=61 |issue=5 |pages=325–8 |year=2004 |pmid=15195718 |doi=}} - review of literature of the past 25 years concludes "No consensus has yet been reached, however, about the number of annual episodes that justify tonsillectomy"</ref> or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a [[tonsillectomy]] can be performed to remove the tonsils. Patients whose tonsils have been removed are certainly still protected from infection by the rest of their immune system. | |||
[[Bacteria]] feeding on [[mucus]] which accumulates in pits (referred to as "crypts") in the tonsils may produce whitish-yellow deposits known as [[tonsillolith]]s. These may emit an odour due to the presence of [[Volatility (chemistry)|volatile]] [[sulfur]] compounds. | |||
[[Organ hypertrophy|Hypertrophy]] of the tonsils can result in snoring, mouth breathing, disturbed sleep, and [[obstructive sleep apnea]], during which the patient stops breathing and experiences a drop in the oxygen content in the bloodstream. A [[tonsillectomy]] can be curative. | |||
== | In very rare cases, diseases like [[rheumatic fever]]<ref name="pharyngitis-cochrane">{{cite journal |author=Del Mar CB, Glasziou PP, Spinks AB |title=Antibiotics for sore throat |journal=[[Cochrane Library|Cochrane Database Syst Rev]] |volume= |issue=2 |pages=CD000023 |year=2004 |pmid=15106140 |doi=10.1002/14651858.CD000023.pub2 |url=http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000023/frame.html}} - Meta-analysis of published research</ref> or [[glomerulonephritis]]<ref name="pmid11344703">{{cite journal |author=Zoch-Zwierz W, Wasilewska A, Biernacka A, ''et al'' |title=[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection] |language=Polish |journal=Wiad. Lek. |volume=54 |issue=1-2 |pages=56–63 |year=2001 |pmid=11344703 |doi=}}</ref> can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.<ref>{{cite journal | title=Antibiotics for sore throat to prevent rheumatic fever: Yes or No? How the Cochrane Library can help | journal=CMAJ | month=September 28 | year=2004 | volume=171 | issue=7 | id={{doi|10.1503/cmaj.1041275}} | url=http://www.cmaj.ca/cgi/content/full/171/7/721 | author=Ohlsson, A. | pages=721}} - Canadian Medical Association Journal commentary on Cochrane analysis</ref><ref>{{cite journal | title=Treatment of sore throat in light of the Cochrane verdict: is the jury still out? | journal=MJA | year=2002 | volume=177 | issue=9 | pages=512-515| url=http://www.mja.com.au/public/issues/177_09_041102/dan10028_fm.html}} - Medical Journal of Australia commentary on Cochrane analysis</ref> | ||
The complications can be listed as | |||
* Blocked [[airway]] from swollen tonsils | |||
* [[Dehydration]] from [[difficulty swallowing]] fluids | |||
* [[Peritonsillar abscess]] in other parts of the throat behind the tonsils | |||
* Post-streptococcal [[glomerulonephritis]] | |||
* [[Rheumatic fever]] and other heart problems | |||
==Prognosis== | |||
Tonsillitis symptoms due to strep usually get better about 2 or 3 days after you start the antibiotics. Children with strep throat should generally be kept home from school or day care until they have been on antibiotics for 24 hours. This helps reduce the spread of illness. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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Complications
An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess (or quinsy). Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre's syndrome).
In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years),[1][2][3] or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy can be performed to remove the tonsils. Patients whose tonsils have been removed are certainly still protected from infection by the rest of their immune system.
Bacteria feeding on mucus which accumulates in pits (referred to as "crypts") in the tonsils may produce whitish-yellow deposits known as tonsilloliths. These may emit an odour due to the presence of volatile sulfur compounds.
Hypertrophy of the tonsils can result in snoring, mouth breathing, disturbed sleep, and obstructive sleep apnea, during which the patient stops breathing and experiences a drop in the oxygen content in the bloodstream. A tonsillectomy can be curative.
In very rare cases, diseases like rheumatic fever[4] or glomerulonephritis[5] can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.[6][7]
The complications can be listed as
- Blocked airway from swollen tonsils
- Dehydration from difficulty swallowing fluids
- Peritonsillar abscess in other parts of the throat behind the tonsils
- Post-streptococcal glomerulonephritis
- Rheumatic fever and other heart problems
Prognosis
Tonsillitis symptoms due to strep usually get better about 2 or 3 days after you start the antibiotics. Children with strep throat should generally be kept home from school or day care until they have been on antibiotics for 24 hours. This helps reduce the spread of illness.
References
- ↑ "6.3 Referral Criteria for Tonsillectomy". Management of Sore Throat and Indications for Tonsillectomy. Scottish Intercollegiate Guidelines Network. 1999. ISBN 1-899893-66-0. Unknown parameter
|month=ignored (help); External link in|publisher=(help) - notes though that these criteria "have been arrived at arbitrarily" from:
Paradise JL, Bluestone CD, Bachman RZ; et al. (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. PMID 6700642. - ↑ Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M (2002). "Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children". Pediatrics. 110 (1 Pt 1): 7–15. doi:10.1542/peds.110.1.7. PMID 12093941. - this later study by the same team looked at less severely affected children and concluded "modest benefit conferred by tonsillectomy or adenotonsillectomy in children moderately affected with recurrent throat infection seems not to justify the inherent risks, morbidity, and cost of the operations"
- ↑ Wolfensberger M, Mund MT (2004). "[Evidence based indications for tonsillectomy]". Ther Umsch (in German). 61 (5): 325–8. PMID 15195718. - review of literature of the past 25 years concludes "No consensus has yet been reached, however, about the number of annual episodes that justify tonsillectomy"
- ↑ Del Mar CB, Glasziou PP, Spinks AB (2004). "Antibiotics for sore throat". Cochrane Database Syst Rev (2): CD000023. doi:10.1002/14651858.CD000023.pub2. PMID 15106140. - Meta-analysis of published research
- ↑ Zoch-Zwierz W, Wasilewska A, Biernacka A; et al. (2001). "[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection]". Wiad. Lek. (in Polish). 54 (1–2): 56–63. PMID 11344703.
- ↑ Ohlsson, A. (2004). "Antibiotics for sore throat to prevent rheumatic fever: Yes or No? How the Cochrane Library can help". CMAJ. 171 (7): 721. doi:10.1503/cmaj.1041275. Unknown parameter
|month=ignored (help) - Canadian Medical Association Journal commentary on Cochrane analysis - ↑ "Treatment of sore throat in light of the Cochrane verdict: is the jury still out?". MJA. 177 (9): 512–515. 2002. - Medical Journal of Australia commentary on Cochrane analysis